Provider Demographics
NPI:1659886752
Name:AIM PEDIATRIC PHYSICAL THERAPY LLC
Entity Type:Organization
Organization Name:AIM PEDIATRIC PHYSICAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:K
Authorized Official - Last Name:SODEMANN
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT
Authorized Official - Phone:701-330-7417
Mailing Address - Street 1:51 STEPHANIE LN
Mailing Address - Street 2:
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59718-8528
Mailing Address - Country:US
Mailing Address - Phone:701-330-7417
Mailing Address - Fax:
Practice Address - Street 1:51 STEPHANIE LN
Practice Address - Street 2:
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59718-8528
Practice Address - Country:US
Practice Address - Phone:701-330-7417
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-11
Last Update Date:2021-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM45132251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM12775121OtherCAQH
NM27427277Medicaid